Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 12009911A | IN |
NPI | 1013102417 |
---|---|
Provider Name | Dr. Kevin Thomas Jarrell |
First Address | Kokomo, IN 46902-3674 |
Second Address | Kokomo, IN 46902-3674 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2007 |
Last Update Date | 09/09/2007 |